Endometriosis

What is endometriosis?

Endometriosis is a chronic and painful condition affecting 10% of women. It occurs when endometrial tissue from the uterus refluxes through the fallopian tubes to implant itself within the pelvic cavity. With this, the ovulation occurring over successive menstrual cycles stimulate these endometrial implants leading to swelling, bleeding and adhesions forming in the pelvis.

What are the symptoms of endometriosis?

It causes cyclical pelvic pain often worsening over the ovulatory phase of the menstrual cycle. It causes pelvic pain, dyspareunia (painful sexual intercourse), infertility (due to adhesions forming), bowel symptoms (diarrhoea and constipation). 

How is endometriosis diagnosed?

The diagnosis of endometriosis is often made at the time of laparoscopy. Before surgery, careful per vaginal examination, digital rectal examination in combination with pelvic ultrasonography to assess the pelvic organs and its mobility and MRI can help make the diagnosis. 

Endometriosis Surgery Terence Chua Brisbane Endometriosis Surgery.

How is endometriosis treated? 

Treatment of endometriosis include 1) medical therapy (oral contraception / contraceptive devices) and 2) minimally invasive surgery by operative laparoscopy. 

What is important about endometriosis surgery? 

Advanced endometriosis (stage 4) often occludes and infiltrate the pouch of douglas. It at times causes severe thickening of the pelvic peritoneum and plasters the rectovaginal septum. The endometriosis implanting itself in these regions need to be removed and its removal may at times necessitate the involvement of a colorectal surgeon. Failure to remove these components of the disease result in ongoing pelvic pain, infertility due to block tubes / kinked tubes.

If bowel symptoms feature as a significant symptom of endometriosis, a rectal resection may be required.

If fertility is the priority and goal of care, full dissection of the pelvis with mobilization of the rectum down pass the rectovaginal septum to allow freeing up of the uterosacral ligaments, uterus, fallopian tubes and ovary through a combined surgical effort with a laparoscopic gynaecologist and colorectal surgeon to eradicate as much endometriosis deposits within the pelvis will improve the chances of natural conception and fertility treatment such as in-vitro fertilization (IVF).